WE HEREBY CERTIFY THAT THE INFORMATION GIVEN
IN THIS APPLICATION IS TRUE TO THE BEST OF OUR KNOWLEDGE, THAT WE ARE FREE TO
INTERMARRY UNDER THE LAWS OF THIS STATE AND THE LAWS OF THE JURISDICTION
WHERE WE RESIDE AND WE ARE THE IDENTICAL PERSONS NAMED IN THE ACCOMPANYING
PHYSICIAN'S CERTIFICATES.

AFFIDAVIT

17. Groom (Sign Full Name)

►

18.
Bride (Sign Full Name)

►

19. Subscribed and Sworn To Before Me On:

20.
Signature of County Clerk

By

Deputy

21. Date of Marriage (Month, Day, Year)

22. Place of Marriage (City, Vill., or
Town. If Rural, Give Twp. Name or Road Dist.)

23. Type of Ceremony (Religious or
Civil) (Specify)

MARRIAGE

RECORD

24. Name of Officiant

25.
Title

26. Date Recorded (Month, Day, Year)

27.
Signature of County Clerk

By

Deputy

VR 600 (1989)

ILLINOIS DEPARTMENT OF
PUBLIC HEALTH – OFFICE OF VITAL RECORDS

(BASED ON 1989 U.S.
STANDARD FORM)

INFORMATION FOR
STATISTICAL PURPOSES ONLY

Race

Education (Specify Highest Grade
Completed)

Number
of This Marriage

If
Previously Married – Last Marriage Ended by Death, Dissolution or Invalidity
of Marriage

SPECIFY (e.g.
WHITE, BLACK, AMERICAN INDIAN, ETC.)

ELEMENTARY OR
SECONDARY (0-12)

COLLEGE (1-4 OR 5 +)

FIRST-SECOND ETC. (SPECIFY)

SPECIFY HOW

SPECIFY WHEN (MONTH,
DAY, YEAR)

SPECIFY WHERE-COUNTY
& STATE

GROOM

28.

29.

30a.

30b.

30c.

30d.

BRIDE

31.

32.

33a.

33b.

33c.

33d.

34. Of Hispanic Origin?

34a.

□
No

□
Yes

34b.

□ No

□ Yes

(Specify No or Yes – If yes,
specify

GROOM

BRIDE

Cuban, Mexican, Puerto
Rican, etc.)

Specify:

Specify:

IL 482-0010

AFFIDAVIT OF CONSENT OF
PARENT OR GUARDIAN FOR MARRIAGE OF MINOR

STATE OF ILLINOIS SS.

COUNTY______________________

_________________________________________________
AND _________________________________________________

BEING DULY SWORN, DEPOSES AND SAYS THAT THEY
ARE THE PARENTS OR GUARDIAN OF_______________________,

A MINOR, AND GIVE THEIR
CONSENT TO THE MARRIAGE OF SAID MINOR TO___________________________________, AND

AFFIANTS FURTHER SAY THAT THE SAID MINOR WAS
BORN__________________, 19____.

SIGNATURE OF FATHER OR GUARDIAN

SIGNATURE OF MOTHER OR GUARDIAN

SUBSCRIBED AND SWORN TO BEFORE ME THIS ______
DAY OF ____________________________, 19______.

SIGNATURE OF COUNTY CLERK
OR NOTARY

STATE OF ILLINOIS SS.

COUNTY______________________

_________________________________________________
AND __________________________________________________

BEING DULY SWORN, DEPOSES AND SAYS THAT THEY
ARE THE PARENTS OR GUARDIAN OF_______________________,

A
MINOR, AND GIVE THEIR CONSENT TO THE MARRIAGE OF SAID MINOR TO_________________________________,
AND

AFFIANTS FURTHER SAY THAT THE SAID MINOR WAS
BORN__________________, 19____.

SIGNATURE OF FATHER OR GUARDIAN

SIGNATURE OF MOTHER OR GUARDIAN

SUBSCRIBED AND SWORN TO BEFORE ME THIS ______
DAY OF ____________________________, 19______.